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Power HA, Shivak SM, Kim J, Wright KD. A systematic review of attention-deficit/hyperactivity disorder in people living with cystic fibrosis. Pediatr Pulmonol 2024; 59:825-833. [PMID: 38197494 DOI: 10.1002/ppul.26843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/22/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024]
Abstract
There is a lack of research that has focused on attention-deficit hyperactivity disorder (ADHD) in people with cystic fibrosis (pwCF). Given ADHD is associated with executive functioning impairments, exploring ADHD in the context of living with cystic fibrosis (CF) is of great importance. The purpose of the current systematic review was to examine ADHD in pwCF across the lifespan in terms of its prevalence, its impact on various health outcomes, and treatments for managing ADHD. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles reporting studies of any design that focused on ADHD in pwCF were included. Studies were excluded if they did not meet this criterion and if they were written in languages other than English. PsycINFO, MEDLINE, EMBASE, and CINAHL databases were searched. Search items were based on three concepts: (1) terms related to CF, (2) terms related to ADHD, and (3) terms related to age. Ten studies were included in this systematic review. Reported prevalence rates of ADHD in pwCF ranged from 5.26% to 21.9%. The reported relationships between ADHD and CF and other health outcomes is inconsistent. In terms of treatment considerations, pharmacological interventions and behavioural strategies for managing ADHD in the context of living with CF have been reported as being successful. Additional research is needed to further explore ADHD in the CF population and health variables that may be associated with CF prognosis.
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Affiliation(s)
- Hilary A Power
- Department of Psychology, University of Regina, Regina, Canada
| | - Shelby M Shivak
- Department of Psychology, University of Regina, Regina, Canada
| | - Jinsoo Kim
- Department of Psychology, University of Regina, Regina, Canada
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, Canada
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2
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Kasahara S, Kanda S, Takahashi M, Fujioka M, Morita T, Matsudaira K, Sato N, Hattori M, Momose T, Niwa SI, Uchida K. Case Report: Guanfacine and methylphenidate improved chronic lower back pain in autosomal dominant polycystic kidney disease with comorbid attention deficit hyperactivity disorder and autism spectrum disorder. Front Pediatr 2023; 11:1283823. [PMID: 38027301 PMCID: PMC10646415 DOI: 10.3389/fped.2023.1283823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is an inherited renal disease characterized by the bilateral development of multiple cysts in the kidneys. Pain management is a clinically important issue, especially because approximately 60% of patients with ADPKD experience chronic pain related to hemorrhage from renal cysts, which significantly reduces their daily life. The cystic fibrosis transmembrane conductance regulator, the molecule responsible for cyst formation in ADPKD, is also the cause of cystic fibrosis. Since attention deficit hyperactivity disorder (ADHD) is known to occur frequently in conjunction with cystic fibrosis, ADPKD may be associated with ADHD. However, to our knowledge, no study has investigated 1) ADHD or autism spectrum disorder (ASD) as comorbidities with ADPKD, 2) the effects of ADHD medications on chronic pain in ADPKD, or 3) cerebral blood flow corresponding to guanfacine (GF) or methylphenidate (MP) treatment for chronic pain. We report the case of a 15-year-old girl with ADPKD, who had chronic back pain associated with ADPKD and had to withdraw from high school because the pain interfered with her daily life. Although she took antihypertensive medications to prevent bleeding, they did not provide adequate blood pressure control. The patient was referred to a child psychiatrist and diagnosed with ASD; however, the pain did not improve. Subsequently, she was referred to our pain center. The diagnosis of ADHD was confirmed and treatment with ADHD medications was initiated. Monotherapy with MP, atomoxetine, and GF resulted in hypertension and hypotension as side effects; however, a combination of MP 18 mg and GF 4 mg provided pain relief and moderate blood pressure control, and the patient was able to go on to college. During the course of treatment, there was an improvement in the distribution of cerebral blood flow in the prefrontal and insular cortices. Confirmation of an ADHD diagnosis comorbid with ASD enabled the use of ADHD medications. The combination of MP and GF improved chronic back pain and high blood pressure due to ADPKD and cerebral blood flow. Screening for ADHD is important in the treatment of ADPKD.
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Affiliation(s)
- Satoshi Kasahara
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Shoichiro Kanda
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Miwako Takahashi
- Institute for Quantum Medical Science, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - Mao Fujioka
- Department of Neuropsychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Taito Morita
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Ko Matsudaira
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Naoko Sato
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Motoshi Hattori
- Department of Pediatric Nephrology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Toshimitsu Momose
- Institute of Engineering Innovation, School of Engineering, The University of Tokyo, Tokyo, Japan
| | - Shin-Ichi Niwa
- Department of Psychiatry, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
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3
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Georgiopoulos AM, Christon LM, Filigno SS, Mueller A, Prieur MG, Boat TF, Smith BA. Promoting emotional wellness in children with CF, part II: Mental health assessment and intervention. Pediatr Pulmonol 2021; 56 Suppl 1:S107-S122. [PMID: 32706527 DOI: 10.1002/ppul.24977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 07/20/2020] [Indexed: 01/04/2023]
Abstract
This is the second of two companion papers that examine the emotional wellness of children with cystic fibrosis (CF) during the early years of life, defined here as the period between birth and age 12. Both papers promote optimal mental health and well-being, with an emphasis on early identification and intervention. The first paper explores child and family resilience. Here, we discuss strategies for pediatric CF teams to provide routine, systematic mental health assessment, anticipatory guidance, brief intervention, and triage to evidence-based treatment when needed, while addressing barriers to accessing care. Many mental health conditions emerge before the age of 12, with the potential for lifelong effects on individuals, their families, and society. Living with a chronic illness such as CF can further increase the risk of mental health concerns and, in a bidirectional manner, their consequences for the quality of life, sustaining daily care, and health outcomes. There has been a significant focus in recent years on the mental health and wellness of adolescents and adults with CF, but less attention to specifics of depression and anxiety in younger children, or to other common pediatric comorbidities including trauma, developmental disorders such as attention-deficit/hyperactivity disorder or autism spectrum disorder, and oppositional behavior. Given the availability of psychometrically sound screening instruments and effective interventions, routinely addressing the mental health of children with CF and their families is feasible to integrate within multidisciplinary CF care, allowing for a personalized approach respecting individual needs, values, and goals.
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Affiliation(s)
| | - Lillian M Christon
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Stephanie S Filigno
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amy Mueller
- Departments of Pulmonology and Social Work Services, Hartford Hospital, Hartford, Connecticut
| | - Mary G Prieur
- Departments of Psychiatry and Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina
| | - Thomas F Boat
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Beth A Smith
- Departments of Psychiatry and Pediatrics, University at Buffalo--The State University of New York, Buffalo, New York
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Gold A, Young JM, Solomon M, Grasemann H. Neuropsychological outcomes following pediatric lung transplantation. Pediatr Pulmonol 2020; 55:2427-2436. [PMID: 32567252 DOI: 10.1002/ppul.24915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/18/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Lung transplantation (LTx) is a treatment option for eligible children with end-stage pulmonary diseases. Improving our understanding of longer-term developmental outcomes in pediatric LTx recipients is important for strategized interventions targeting cognitive difficulties. METHODS Neuropsychological assessments were completed for children who received LTx at our center (2009-2017). Assessments comprised tasks of general intellect, memory, visual-perception, academics, and executive functioning as well as caregiver questionnaires of adaptive, executive, emotional, and behavioral functioning. Results were compared to age-matched population norms. Between-group nonparametric tests were performed pre-LTx vs post-LTx and for children with a primary diagnosis of cystic fibrosis (CF) vs other diagnoses (non-CF). RESULTS Neuropsychological outcomes were assessed for 21 children post-LTx, with a median age (interquartile range) at the time of transplant of 11.52 (6.89, 14.12) years. Eleven children completed pre- and post-transplant assessments and within this group, improvements for verbal learning (P = .02), aspects of mood, behavior, and adaptive functioning were observed over time (all P < .05). Post-transplant whole group analysis suggested age-appropriate abilities across most cognitive domains, with a relative weakness for executive functioning. Emotional or behavioral difficulties were not endorsed by caregivers. Across pulmonary diagnoses, higher levels of emotional, behavioral, and executive functioning difficulty were reported in the non-CF group (all P < .05). CONCLUSIONS Overall, LTx has a positive impact on cognitive functioning, particularly learning, adaptive functioning, mood, and behavior. Children transplanted for non-CF related diseases demonstrated greater challenges, highlighting the need for targeted assessments and interventions across the transplant process to support the complex needs of this population.
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Affiliation(s)
- Anna Gold
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julia Mary Young
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melinda Solomon
- Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Hartmut Grasemann
- Transplant and Regenerative Medicine Center, The Hospital for Sick Children, Toronto, Ontario, Canada.,Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Translational Medicine, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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5
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Behrhorst KL, Everhart RS, Schechter MS. Mental Health in Cystic Fibrosis. Respir Med 2020. [DOI: 10.1007/978-3-030-42382-7_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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6
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Gundogdu U, Fis NP, Eralp EE, Karadag BT. Major depression and psychiatric comorbidity in Turkish children and adolescents with cystic fibrosis. Pediatr Pulmonol 2019; 54:1927-1935. [PMID: 31456343 DOI: 10.1002/ppul.24492] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Accepted: 08/05/2019] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many psychological factors contribute to an increased risk of depression in children and adolescents with cystic fibrosis (CF). This study aims to evaluate coexisting psychiatric disorders, perceived social support, and quality of life (QoL) in Turkish children with CF and compare these factors with those of a control group. METHODS The study group consisted of 32 children (8-16 years of age) with CF and a group of 33 age- and sex-matched control children. All subjects completed the Children's Depression Inventory (CDI), Screen for Child Anxiety and Related Disorders (SCARED), Social Support Appraisals Scale, and Pediatric Quality of Life Questionnaire. Psychiatric diagnoses were established using the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. RESULTS Of the children with CF, 80% of those in the 8 to 11 years age range and 50% of those in the 12 to 17 years age range had at least one psychiatric disorder, that is, 68% of the 33 children with CF had at least one psychiatric disorder. Anxiety disorder (46.8%) and attention deficit and hyperactivity disorder (21.8%) were also common among children with CF. The rates of depression in the CF group and control group were 21.9% and 6.1%, respectively (P > .05). The CF subjects with coexisting depression exhibited higher levels of disease severity, longer periods of hospitalization, and more frequent anxiety disorder. When compared with the control group, the QoL among the Turkish children with CF was lower (P < .05). The CDI and SCARED are relatively sensitive and specific screening tools for depression and anxiety in children with CF. CONCLUSIONS Psychiatric disorders were more frequently found in children and adolescents with CF. By examining symptoms of anxiety and depression and by using screening tools, CF patients who exhibit symptoms of psychiatric disorders can be better identified and evaluated.
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Affiliation(s)
| | - Nese P Fis
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Ela E Eralp
- Department of Pediatric Pulmonology, Faculty of Medicine, Marmara University, İstanbul, Turkey
| | - Bulent T Karadag
- Department of Pediatric Pulmonology, Faculty of Medicine, Marmara University, İstanbul, Turkey
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Biederman J, Fried R, DiSalvo M, Storch B, Pulli A, Woodworth KY, Biederman I, Faraone SV, Perlis RH. Evidence of Low Adherence to Stimulant Medication Among Children and Youths With ADHD: An Electronic Health Records Study. Psychiatr Serv 2019; 70:874-880. [PMID: 31242830 DOI: 10.1176/appi.ps.201800515] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate rates and correlates of stimulant medication adherence in a sample of pediatric patients using data derived from electronic medical records (EMRs) from a large health care organization in a large metropolitan area. The study relied on a novel definition of medication adherence as a timely renewal of an index prescription determined using the electronically recorded issuance of a stimulant prescription in the EMR ("refill"). METHODS Prescription and sociodemographic data were extracted from the Partners HealthCare Research Patient Data Registry to calculate adherence to stimulant medication treatment. RESULTS In the EMR, 2,206 patients with prescriptions for central nervous system stimulant medication were identified. Results showed that 46% of the index prescriptions were refilled within the timeframe necessary for the patient to be considered consistently medicated. A multivariable logistic regression model predicting medication adherence from patient demographic and treatment characteristics yielded an area-under-the-curve statistic of 0.57, indicating that these characteristics predicted adherence only modestly better than chance. CONCLUSIONS EMR data from a large health care organization showed that 46% of pediatric patients were adherent to treatment with stimulants. Rates of medication adherence were worse among patients receiving care from a primary care provider than among those receiving care from a psychiatrist, in older patients, and in female patients and did not appear to be influenced by racial-ethnic group, economic class, stimulant type, or medication formulation (short or long acting). These findings, which show low rates of medication adherence among children and adolescents with ADHD, suggest the need for efforts to improve these rates.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Barbara Storch
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Alexa Pulli
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Itai Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Stephen V Faraone
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Roy H Perlis
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
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Spitzer N, Legare TB, Patel P, Toselli N, Livingston F. The Prevalence and Effect of Comorbid Cystic Fibrosis and Attention Deficit Hyperactivity Disorders on Hospitalizations: A Retrospective Analysis. Cureus 2018; 10:e3048. [PMID: 30397565 PMCID: PMC6207276 DOI: 10.7759/cureus.3048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: The prevalence of attention-deficit/hyperactivity disorder (ADHD) in pediatric cystic fibrosis (CF) patients is comparable to the general population, but the effects of ADHD on CF treatment and the outcomes have been minimally investigated. Methods: Two cohorts were retrospectively reviewed, pediatric patients with comorbid CF/ADHD and patients with CF only. Each patient with CF/ADHD was age and sex-matched to a CF-only patient based on their most recent pulmonary office visit. Each patient was reviewed for forced expiratory volume in one-second percent predicted (FEV1%pred), body mass index (BMI) percentile, and hospitalizations for one year prior to the last pulmonary visit. Results: A total of 624 patients with CF were identified, with 52 having co-morbid CF/ADHD (8.3%). Of those identified, 46 met inclusion criteria and were analyzed in the CF/ADHD cohort. The mean total hospital admissions between the CF/ADHD cohort and the CF-only cohort were not statistically significant (2.22 vs 1.834, p=.467). The difference between the BMI percentiles was not statistically significant (48.634 vs 38.634, p=.135). The difference between FEV1%pred was statistically significant at 84% for the CF/ADHD group and 74% for the CF-only group (p=.042). Conclusion: The difference in total hospital admissions between the CF/ADHD cohort and the CF-only cohort did not reach statistical significance, but the study was underpowered. There was a significant difference between FEV1%pred between the two groups, in favor of the comorbid CF/ADHD population. More research is needed to further evaluate the effects of a comorbid ADHD diagnosis on outcomes in the CF pediatric population.
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Affiliation(s)
- Nicole Spitzer
- Ophthalmology, University of Central Florida College of Medicine, Orlando, USA
| | - Timothy B Legare
- Surgery, University of Central Florida College of Medicine, Orlando, USA
| | - Priyanshi Patel
- Pediatrics, University of Central Florida College of Medicine, Orlando, USA
| | - Nicholas Toselli
- Miscellaneous, University of Central Florida College of Medicine, Orlando, USA
| | - Floyd Livingston
- Pediatric Pulmonology, Nemours Children's Hospital, Orlando, USA
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Cohen-Cymberknoh M, Tanny T, Breuer O, Blau H, Mussaffi H, Kadosh D, Gartner S, Salinas A, Bentur L, Nir V, Gur M, Reiter J, Shoseyov D, Kerem E, Berger I. Attention deficit hyperactivity disorder symptoms in patients with cystic fibrosis. J Cyst Fibros 2018; 17:281-285. [DOI: 10.1016/j.jcf.2017.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/29/2017] [Accepted: 11/30/2017] [Indexed: 02/05/2023]
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10
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Georgiopoulos AM, Friedman D, Porter EA, Krasner A, Kakarala SP, Glaeser BK, Napoleon SC, Wozniak J. Screening for ADHD in adults with cystic fibrosis: Prevalence, health-related quality of life, and adherence. J Cyst Fibros 2018; 17:276-280. [DOI: 10.1016/j.jcf.2017.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/11/2017] [Accepted: 08/14/2017] [Indexed: 12/11/2022]
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11
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Clinical and Sociodemographic Factors Associated With Attention-Deficit/Hyperactivity Disorder in Patients With Cystic Fibrosis. PSYCHOSOMATICS 2015; 56:495-503. [DOI: 10.1016/j.psym.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 08/26/2014] [Accepted: 09/02/2014] [Indexed: 11/20/2022]
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12
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Snell C, Fernandes S, Bujoreanu IS, Garcia G. Depression, illness severity, and healthcare utilization in cystic fibrosis. Pediatr Pulmonol 2014; 49:1177-81. [PMID: 24619910 DOI: 10.1002/ppul.22990] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 01/05/2014] [Indexed: 11/07/2022]
Abstract
Cystic fibrosis (CF) is an illness associated with high healthcare utilization and healthcare costs, even when compared to other chronic illnesses. In a variety of medical populations, depression has been found to be associated with lower adherence and poorer medical outcomes. The current study is a retrospective chart review of a matched set of 40 patients with CF, half with and half without a depressive disorder diagnosis. Participants were matched on the basis of their age, gender and lung function, and compared in terms of their illness severity (lung function and weight), medical adherence, and healthcare utilization during the year prior to and following diagnosis of depression and a comparable time period for the non-depressed group. Results show an association between depression and BMI, with only the depressed group showing significant decreases in the year following their depressive disorder diagnosis (from a mean BMI z-score of -0.48 to -1.04). Depression was also strongly associated with greater healthcare utilization and healthcare costs relative to those of comparably medically ill controls, in that depressed youth were hospitalized at over three times the rate of non-depressed youth, and their healthcare costs were more than four times higher (mean number of admissions per year for the depressed group of 4.00 vs. 1.20 for the non-depressed group; mean annual costs of $280,000 for the depressed vs. $60,116 for the non-depressed). These findings highlight the importance of addressing the mental health needs of chronically ill patients as a path to better health outcomes and decreasing need for medical services.
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Affiliation(s)
- Carolyn Snell
- Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, Massachusetts, 02115
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13
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Marcorelles P, Friocourt G, Uguen A, Ledé F, Férec C, Laquerrière A. Cystic fibrosis transmembrane conductance regulator protein (CFTR) expression in the developing human brain: comparative immunohistochemical study between patients with normal and mutated CFTR. J Histochem Cytochem 2014; 62:791-801. [PMID: 25062999 DOI: 10.1369/0022155414546190] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cystic Fibrosis Transmembrane conductance Regulator (CFTR) protein has recently been shown to be expressed in the human adult central nervous system (CNS). As CFTR expression has also been documented during embryonic development in several organs, such as the respiratory tract, the intestine and the male reproductive system, suggesting a possible role during development we decided to investigate the expression of CFTR in the human developing CNS. In addition, as some, although rare, neurological symptoms have been reported in patients with CF, we compared the expression of normal and mutated CFTR at several fetal stages. Immunohistochemistry was performed on brain and spinal cord samples of foetuses between 13 and 40 weeks of gestation and compared with five patients with cystic fibrosis (CF) of similar ages. We showed in this study that CFTR is only expressed in neurons and has an early and widespread distribution during development. Although we did not observe any cerebral abnormality in patients with CF, we observed a slight delay in the maturation of several brain structures. We also observed different expression and localization of CFTR depending on the brain structure or the cell maturation stage. Our findings, along with a literature review on the neurological phenotypes of patients with CF, suggest that this gene may play previously unsuspected roles in neuronal maturation or function.
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Affiliation(s)
- Pascale Marcorelles
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
| | - Gaëlle Friocourt
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
| | - Arnaud Uguen
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
| | - Françoise Ledé
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
| | - Claude Férec
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
| | - Annie Laquerrière
- Pathology Laboratory, Pole Pathologie-Biologie, Brest University Hospital, Brest, France (PM, AU, FL)Laboratory of Neurosciences of Brest, Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (PM)Inserm, UMR1078, Brest, France (GF, CF)Brest University, Faculté de Médecine et des Sciences de la Santé, Brest, France (GF, CF)CHRU Brest, Laboratory of Molecular Genetics and Histocompatibility, Brest, France (GF, CF)Pathology Laboratory, Rouen University Hospital, Rouen, France (AL)NeoVasc Region-Inserm Team ERI28, Laboratory of Microvascular Endothelium and Neonate Brain Lesions, Institute of Research for Innovation in Biomedicine, University of Rouen, Rouen, France (AL)
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Goldbeck L, Fidika A, Herle M, Quittner AL. Psychological interventions for individuals with cystic fibrosis and their families. Cochrane Database Syst Rev 2014; 2014:CD003148. [PMID: 24941199 PMCID: PMC7388585 DOI: 10.1002/14651858.cd003148.pub3] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND With increasing survival estimates for individuals with cystic fibrosis, long-term management has become an important focus. Psychological interventions are largely concerned with adherence to treatment, emotional and social adaptation and health-related quality of life. We are unaware of any relevant systematic reviews. OBJECTIVES To determine whether psychological interventions for people with cystic fibrosis provide significant psychosocial and physical benefits in addition to standard medical care. SEARCH METHODS Studies were identified from two Cochrane trials registers (Cystic Fibrosis and Genetic Disorders Group; Depression, Anxiety and Neurosis Group), Ovid MEDLINE and PsychINFO; unpublished trials were located through professional networks and Listserves. Most recent search of the Cystic Fibrosis and Genetic Disorders Group's register: 19 December 2013.Most recent search of the Depression, Anxiety and Neurosis Group's register: 12 November 2013. SELECTION CRITERIA Randomised controlled studies of a broad range of psychological interventions evaluating subjective and objective health outcomes, such as quality of life or pulmonary function, in individuals of all ages with cystic fibrosis and their immediate family. We were interested in psychological interventions, including psychological methods within the scope of psychotherapeutic or psychosomatic mechanism of action (e.g. cognitive behavioural, cognitive, family systems or systemic, psycho-dynamic, or other, e.g. supportive, relaxation, or biofeedback), which were aimed at improving psychological and psychosocial outcomes (e.g. quality of life, levels of stress or distress, psychopathology, etc.), adaptation to disease management and physiological outcomes. DATA COLLECTION AND ANALYSIS Three authors were involved in selecting the eligible studies and two of these authors assessed their risk of bias. MAIN RESULTS The review includes 16 studies (eight new studies included in this update) representing data from 556 participants. Studies are diverse in their design and their methods. They cover interventions with generic approaches, as well as interventions developed specifically to target disease-specific symptoms and problems in people with cystic fibrosis. These include cognitive behavioural interventions to improve adherence to nutrition or psychosocial adjustment, cognitive interventions to improve adherence or those associated with decision making in lung transplantation, a community-based support intervention and other interventions, such as self-hypnosis, respiratory muscle biofeedback, music therapy, dance and movement therapy, and a tele-medicine intervention to support patients awaiting transplantation.A substantial proportion of outcomes relate to adherence, changes in physical status or other specific treatment concerns during the chronic phase of the disease.There is some evidence that behavioural interventions targeting nutrition and growth in children (4 to 12 years) with cystic fibrosis are effective in the short term. Evidence was found that providing a structured decision-making tool for patients considering lung transplantation improves patients' knowledge of and expectations about the transplant, and reduces decisional conflict in the short term. One study about training in biofeedback-assisted breathing demonstrated some evidence that it improved some lung function measurements. Currently there is insufficient evidence for interventions aimed at other aspects of the disease process. AUTHORS' CONCLUSIONS Currently, insufficient evidence exists on psychological interventions or approaches to support people with cystic fibrosis and their caregivers, although some of the studies were promising. Due to the heterogeneity between studies, more of each type of intervention are needed to support preliminary evidence. Multicentre studies, with consequent funding implications, are needed to increase the sample size of these studies and enhance the statistical power and precision to detect important findings. In addition, multicentre studies could improve the generalisation of results by minimizing centre or therapist effects. Psychological interventions should be targeted to illness-specific symptoms or behaviours to demonstrate efficacy.
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Affiliation(s)
- Lutz Goldbeck
- Dptm. Child and Adolescent Psychiatry/Psychotherapy, University Clinic Ulm, Steinhoevelstr. 5, Ulm, Baden-Württemberg, Germany, D-89075
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15
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Chen DF, Tsai TC, Su YT, Lin CW. Hospital-based school for children with chronic illness in Taiwan. J Formos Med Assoc 2014; 114:995-9. [PMID: 24461878 DOI: 10.1016/j.jfma.2013.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 12/19/2013] [Accepted: 12/24/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. METHODS The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. RESULTS Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. CONCLUSION The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children.
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Affiliation(s)
- Der-Fang Chen
- Department of Surgery, E-Da Hospital, Kaohsiung City, Taiwan
| | - Tsuen-Chiuan Tsai
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan; Department of Chinese Medicine, I-Shou University, Kaohsiung City, Taiwan.
| | - Yu-Tsun Su
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
| | - Chi-Wei Lin
- Department of Medical Education, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan; Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung City, Taiwan
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16
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Tluczek A, Laxova A, Grieve A, Heun A, Brown RL, Rock MJ, Gershan WM, Farrell PM. Long-term follow-up of cystic fibrosis newborn screening: psychosocial functioning of adolescents and young adults. J Cyst Fibros 2013; 13:227-34. [PMID: 24157354 DOI: 10.1016/j.jcf.2013.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/30/2013] [Accepted: 10/02/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Long-term psychosocial outcomes of cystic fibrosis (CF) patients diagnosed through newborn screening remain unknown. METHODS This cross-sectional study compared three groups of youths (16 to 22 years): CF patients diagnosed through NBS (CF-NBS, n = 13), CF patients diagnosed through standard practice (CF-SP, n = 26) and healthy peers (H, n = 42), plus 72 of their parents. We hypothesized that adolescent psychological functioning would be mediated by parent depression and quality of parent-child communication and cohesiveness. RESULTS A path analysis showed significantly more depression among CF-NBS group parents (p = .006-.008). Parent-child cohesiveness was related to communication (p < .001). Cohesiveness and communication were associated with youth Internalizing Problems (p = .037, p = .009), Emotional Symptoms (p = 0.018, p = 0.022), and Personal Adjustment (communication only, p = 0.009). Parent depression was related to youth Personal Adjustment (p = 0.022). CONCLUSIONS CF patients report psychosocial function similar to healthy peers. Parents of children diagnosed with CF through NBS may be at risk for depressive symptoms when their children reach adolescence.
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Affiliation(s)
- Audrey Tluczek
- University of Wisconsin, School of Nursing, Madison, WI, United States; University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States.
| | - Anita Laxova
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - Adam Grieve
- University of Wisconsin, School of Medicine and Public Health, Department of Psychiatry, Madison, WI, United States
| | - Anne Heun
- Iowa Health Des Moines, Blank Children's Hospital and John Stoddard Cancer Center, Des Moines, IA, United States
| | - Roger L Brown
- University of Wisconsin, School of Nursing, Madison, WI, United States
| | - Michael J Rock
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
| | - William M Gershan
- University of Utah, School of Medicine, Department of Pediatrics, Salt Lake City, UT, United States
| | - Philip M Farrell
- University of Wisconsin, School of Medicine and Public Health, Department of Pediatrics, Madison, WI, United States
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Ogundele MO. Transitional care to adult ADHD services in a North West England district. ACTA ACUST UNITED AC 2013. [DOI: 10.1108/cgij-01-2013-0001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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